Major NHS change will see GPs paid to keep two million patients out of hospital

GPs will be paid to keep two million patients out of hospital by seeking advice from specialists themselves.

The Government says it will prevent “unnecessary” hospital appointments by setting up a system for GPs to seek advice from hospital doctors over the phone or online, before prescribing medication, accessing blood tests or scans.

Patients for whom GPs can use the new “advice and guidance” system include patients with stomach problems, ear, throat and nose issues and women struggling with symptoms of the menopause. Instead of waiting months for a hospital appointment patients will get a referral typically within a week.

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Health minister Karin Smyth said: "By caring for patients closer to home, we save time and stop masses of people having to head to hospital for unnecessary appointments in the first place. We are rewiring the so that we are doing things differently, more efficiently and delivering better outcomes for patients.”

The Advice and Guidance scheme is already available in parts of the country but £80 million is being provided to GPs to make it nationwide to "stop masses of people" going to hospital. The Government said it will divert up to two million patients away from to receive care closer to home by the end of 2025/26.

Professor Sir Sam Everington, who has been a GP in Tower Hamlets, east London, since 1989, added: "In my experience over two-thirds of patients with kidney disease can be managed in this way with advice from a consultant and treatment by the GP, removing the enormous stress and uncertainty of waiting a long time.

"Advice and guidance enables patients and GPs to get advice direct from a specialist, typically within a week for routine cases. This means that patients get their health problems sorted rapidly, preventing health deterioration and avoiding long waits to be seen.”

From this month, GP practices can now claim for every request raised through this channel between GPs and hospital specialists instead of referring patients onto waiting lists for hospital care which stands at 7.5 million appointments in England. The NHS waiting list has been falling since hitting a record high in September 2023 with 7.8 million treatments following a steady upward trajectory since 2010 when the Tories came to power and it stood at 2.5 million.

Minister Smyth added: “It will take time to reverse the damaging neglect the NHS has suffered in recent years, but our Plan for Change is starting to deliver benefits for patients, with waiting lists cut by 219,000 since July, and 1,500 new GPs in post.”

The Government says patients suffering from something as common as – estimated to affect up to one in five people – can avoid being added to hospital waiting lists which has a backlog of 400,000 appointments for digestive conditions. Instead, after an initial consultation with their family doctor, the GP can seek expert advice and refer the patient directly to dieticians.

Sharon Brennan, director at patient campaign group National Voices, said: “If genuine shared decision-making sits at the centre of the advice and guidance service it has the potential to ensure, where appropriate, patients receive the most suitable care closer to home without having to anxiously sit on consultant waiting lists. To make sure patient develop trust in this new service, we must see real choice offered to patients about what best treatment routes are, and strong communication about what the service is and what it means in practical terms for patient care.”

Advice and guidance has been used in parts of England since 2015. According to DHSC, between July and December last year about 660,000 treatments were diverted from hospitals to the community as a result of the advice and guidance scheme, up 60,000 for the same period in 2023.

Beccy Baird, senior fellow at the King’s Fund thinktank, said: “Supporting people to manage conditions such as irritable bowel syndrome and at home not only reduces hospital waiting lists, but crucially helps patients feel happier and healthier in their own homes. The scheme also encourages stronger collaboration between GPs and hospital specialists.

“However, effective implementation will be key to the scheme’s success, and commissioners must safeguard against potential unintended consequences of the scheme. Financial incentives for GPs based on the number of requests raised could undermine the primary goal of delivering high-quality care and the scheme must avoid introducing unnecessary steps into a patient’s journey.”

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: "Advice and guidance services have the potential to support GPs to refer appropriately and deliver care to patients whilst they are waiting for specialist treatment, but it's crucial that GP services have the capacity to accommodate the shift from hospitals to community care so this funding is a good step in the right direction.

"In the past, some GPs have reported issues with using A&G services, including that they shift care into general practice without appropriate resource, and that they can be used to reject necessary referrals. We have always been supportive of the Government's aspiration to shift more care into the community, and an increasing use of A&G services may help enable this, as long as it is properly resourced across the country.

"Funding must follow the patient, and we need to see significant investment in general practice, following years of underfunding by successive governments.”